132| Reliable Change – A Conversation With Dr. Kevin Duff

In this episode, we discuss reliable change with Dr. Kevin Duff. Specific topics covered include the purpose of serial assessment, classical test theory, test retest reliability, an introduction to practice effects, factors that increase or decrease practice effects, the reliable change index, standardized regression-based equations, and clinical factors impacting the interpretation of reliable change data.

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About Kevin

Dr. Kevin Duff has specialized in neuropsychology for over 20 years. He obtained his Ph.D. in Clinical Psychology from the State University of New York in Albany. He completed his neuropsychology internship at the Southern Arizona Healthcare System in Tucson, AZ, and his post-doctoral fellowship at the University of Oklahoma Health Sciences Center in Oklahoma City. He joined the Psychiatry Department at the University of Iowa in 2003, where had clinical and research responsibilities working with patients with dementia, Huntington’s disease, and a variety of other neuropsychiatric conditions. In 2009, he joined the University of Utah as Associate Professor of Neurology and neuropsychologist for Alzheimer’s Care, Imaging and Research. In 2022, he moved (hopefully for the last time) to Oregon Health & Science University in Portland, where he is the senior neuropsychologist at the Layton Aging & Alzheimer’s Disease Research Center and Professor in their Department of Neurology.

Dr. Duff’s research has focused primarily on the early identification of cognitive decline in neuropsychiatric illnesses. Across multiple studies, Dr. Duff has used short-term practice effects as a marker of brain plasticity in patients with Mild Cognitive Impairment to examine if short-term changes in cognition can predict the diagnosis and prognosis of dementia, as well as its brain pathology and response to interventions. He has published over 180 peer-reviewed papers in scientific journals and he has lectured nationally and internationally on his areas of expertise. His research on practice effects in Mild Cognitive Impairment has been continually funded by the National Institutes of Health since 2005.


Predicting 1 yr scores with baseline and practice effects based on ACN paper

Change score calculator revised

RBANS subtest and index predictor using manual norms


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Beglinger, L. J., Gaydos, B., Tangphao-Daniels, O., Duff, K., Kareken, D. A., Crawford, J., Fastenau, P. S., & Siemers, E. R. (2005). Practice effects and the use of alternate forms in serial neuropsychological testing. Archives of Clinical Neuropsychology, 20(4), 517–529. https://doi.org/10.1016/j.acn.2004.12.003

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Duff, K. (2012). Evidence-based indicators of neuropsychological change in the individual patient: Relevant concepts and methods. Archives of Clinical Neuropsychology, 27(3), 248–261. https://doi.org/10.1093/arclin/acr120

Duff, K., Beglinger, L. J., Moser, D. J., Paulsen, J. S., Schultz, S. K., & Arndt, S. (2010). Predicting cognitive change in older adults: The relative contribution of practice effects. Archives of Clinical Neuropsychology, 25(2), 81–88. https://doi.org/10.1093/arclin/acp105

Durant, J., Duff, K., & Miller, J. B. (2019). Regression-based formulas for predicting change in memory test scores in healthy older adults: Comparing use of raw versus standardized scores. Journal of Clinical and Experimental Neuropsychology, 41(5), 460–468. https://doi.org/10.1080/13803395.2019.1571169

Duff, Kevin, Dorociak, K. E., & Yamada, T. H. (2022). Serial assessment in the older patient. A Handbook of Geriatric Neuropsychology, 361–378. https://doi.org/10.4324/9781003100058-23

Duff, K., & Hammers, D. B. (2020). Practice effects in mild cognitive impairment: A validation of Calamia et al. (2012). The Clinical Neuropsychologist, 36(3), 571–583. https://doi.org/10.1080/13854046.2020.1781933

Duff, Kevin, Beglinger, L. J., Schoenberg, M. R., Patton, D. E., Mold, J., Scott, J. G., & Adams, R. L. (2005). Test-retest stability and practice effects of the RBANS in a community dwelling elderly sample. Journal of Clinical and Experimental Neuropsychology, 27(5), 565–575. https://doi.org/10.1080/13803390490918363

Duff, Kevin. (2014). One-week practice effects in older adults: Tools for assessing cognitive change. The Clinical Neuropsychologist, 28(5), 714–725. https://doi.org/10.1080/13854046.2014.920923

Duff, Kevin, Suhrie, K. R., Dalley, B. C. A., Anderson, J. S., & Hoffman, J. M. (2018). External validation of change formulae in neuropsychology with neuroimaging biomarkers: A methodological recommendation and preliminary clinical data. The Clinical Neuropsychologist, 33(3), 478–489. https://doi.org/10.1080/13854046.2018.1484518

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Hammers, D. B., & Duff, K. (2019). Application of different standard error estimates in reliable change methods. Archives of Clinical Neuropsychology, 36(3), 339–346. https://doi.org/10.1093/arclin/acz054

Hammers, D. B., Porter, S., Dixon, A., Suhrie, K. R., & Duff, K. (2020). Validating 1-year reliable change methods. Archives of Clinical Neuropsychology, 36(1), 87–98. https://doi.org/10.1093/arclin/acaa055

Hammers, D. B., Suhrie, K. R., Dixon, A., Porter, S., & Duff, K. (2020). Reliable change in cognition over 1 week in community-dwelling older adults: A validation and extension study. Archives of Clinical Neuropsychology, 36(3), 347–358. https://doi.org/10.1093/arclin/acz076

Hammers, D. B., Suhrie, K. R., Porter, S. M., Dixon, A. M., & Duff, K. (2020). Validation of one-year reliable change in the RBANS for community-dwelling older adults with amnestic mild cognitive impairment. The Clinical Neuropsychologist, 36(6), 1304–1327. https://doi.org/10.1080/13854046.2020.1807058

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